Real World Prevalence and Treatment of Large Vessel Occlusion Stroke (4917)

Objective: We sought to determine the prevalence and treatment rates of consecutive acute ischemic stroke (AIS) patients presenting to an urban, comprehensive stroke center (CSC) with large vessel occlusion (LVO). Background: In 2015, multiple randomized clinical trials established endovascular thrombectomy (ET) as standard of care for LVO stroke. Despite the overwhelming benefit of ET, recent data suggests utilization rates may be as low as 3% for all AIS patients nationwide. Real-world data on the prevalence of LVO are necessary to properly identify the population of potentially ET-eligible patients. Design/Methods: We conducted a retrospective review of directly-presenting, consecutive AIS patients at our CSC from 2017–2018. We calculated the percentage of LVO rate of treatment with ET, stratified by site of occlusion. Results: Of 520 consecutive patients who received vessel imaging, 21.5% (n=112) had LVO. 27.6% (n=29) of 105 patients with 1 site of occlusion were treated with ET. Percentage of LVO and its treatment, stratified by site of occlusion, were: 12.3% (n=13) and 10.3% (n=3) left internal carotid artery (ICA), 15.2% (n=16) and 6.9% (n=2) right ICA, 5.7% (n=6) and 20.7% (n=6) left M1, 11.4% (n=12) and 20.7% (n=6) right M1, 10.5% (n=11) and 20.7% (n=6) left M2, 13.3% (n=14) and 10.3% (n=3) right M2, 1.9% (n=2) and 6.9 (n=2) basilar. 42.9% (n=3) of 7 patients with multiple sites of occlusion received ET, 66.7% (n=2) of whom had vertebral-basilar dual occlusions. Conclusions: In our cohort, 1 in 5 AIS patients had LVO, and of those, almost 1 in 3 had lesions amenable to ET. Prevalence and treatment rates of LVO vary by site of occlusion. Systems of care must prioritize rapid detection and treatment of LVO. Further research may elucidate reasons for variable rates of treatment by site of occlusion. Disclosure: Dr. Erdman has nothing to disclose. Dr. Agarwal has nothing to disclose. Dr. Wheelwright has nothing to disclose. Dr. Jette has received personal compensation in an editorial capacity for Editor of Epilepsia. Dr. Mazumdar has nothing to disclose. Dr. Dhamoon has nothing to disclose. Dr. Stein has nothing to disclose.